Boundaries in Psychotherapy

Ethical standards required in the practice of psychotherapy are high. The clients and the therapists are required to conduct themselves in a particular manner so that the process of counseling is successful. The two groups should avoid certain activities that would otherwise derail the process of counseling and healing. With this in mind, boundaries on the interaction of the patient with the therapists should be developed. Boundaries in psychotherapy refer to matters of interaction with the client such as place, time, and length of sessions, bartering, physical touch, gifts, physical touch, and activities not related to work. With the extensive use of technology and the rise of usage of social sites in the internet, these boundaries have been extended to include the digital world recently too. This paper will delve into various situations that a therapist can find him/her in. It will also look at the possible and ethical ways of conduct.

Vignette One:

Boundaries concerns that may arise with regard to friendships and familial relationships between therapist and therapist and therapist and client are classified into two: Boundary violations and boundary crossings. Boundary violations will occur when the session will take advantage of the relationship. If a therapist makes use of the situation to give the advice that favors their side, then there is a boundary violation involved. Boundary violations are very harmful to any counseling session and man at times its perpetrators are arrested and charged. Boundary crossings on the other hand, are rarely unethical; rather they are helpful in the sessions. Boundary crossings provide information that is vital to the counseling sessions.

This case appears as a non-sexual dual relationship because there is no sexual relationship. Moreover, the commencement of the sessions will not lead to any sexual relationship. From the nature of my friendship with the client’s brother, the relationship can further be characterized as a social dual relationship. The social relationships that are not sexual in nature are not classified as unethical. However, not all of these cases are clean. A look into the activities of some therapist’s proof hat there are situations where these relationships lead to violations.

The decision by my friend not to undertake his sister’s marriage counseling is a wise one since it would have been unethical. Moreover, the fact that he has a relationship with the clients means that his counsel would not have been objective but subjective. Personal relationships often harm the therapy sessions since the therapist is likely to be influenced by personal feelings. On the other hand, he would have done better by referring her to another therapist who is not familiar with the family. My friendship with him would affect the way I impart my counsel.

In this case, there are issues of boundary violations because my relationship with my friend’s sister may make it seem that the advice I will be giving them will favor the sister. Not minding the fact that the advice may be excellent and fair to both the bride and the groom, the existence of a known relationship may make it seem that the session was unethical. On the other hand, boundary crossing on this case helps me to counsel the couple in the best way possible. The knowledge of their past and the freedom to express themselves courtesy of the knowledge of my friendship with the brother will make for a very successful session.

Since my friend stressed the fact that there are a few approved therapists in the vicinity and may be hard to find one I would gladly take the job. First, as help to a colleague who realized that it would not be ethical to take the case himself. Secondly, the knowledge of their background and the trust accorded me would result in a fruitful session. However, because a situation of violation of the boundaries may arise, the presence of a supervisor is necessary. The supervisor will act as a witness to the session and report the proceedings whenever a complaint may arise. Documentation of the counseling plan will ease the work and the risk of undertaking this task. The documentation will also absolve me of any unethical claims in the future.

Keeping of records is a requirement according to Health Insurance Portability and Accountability Act (HIPAA). This information is for use by the psychology association, investigations concerning violations, gauging the psychologist’s performance and referral uses. Although the client and the therapist can decide on the amount of details put in the records, a particular amount of information is required. The nature of the relationship with this client will pose a huge challenge. For instance, in a situation where this client asks me to keep everything confidential as a favor for them, then a situation will arise with the Psychological association if I agree with them. Conversely, if I decide not to agree with them, they will cite betrayal by a friend.

Moreover, a situation may arise in documentation and record keeping since record keeping guidelines provided by APA require that all documentation be inline with the Ethics Code and legal and regulatory requirements. Citing the nature of the relationship with the client may prove a problem in the future of my career since the session is documented. Moreover, record keeping is meant to look like a resume of the therapist. It gives the information on the performance of the therapist. In a situation where the counseling does not go according to plan, a boundary violation may be noted as the cause. Since this case may pose a problem in the future, I may decide to skip some details in my records, which is a violation, according to Health Insurance Portability and Accountability Act (HIPAA).

Vignette Two:

According to psychological associations such as the American Psychological Association (APA), any sexual relationship with a client is prohibited. A prior, existing or a foreseeable sexual activity is considered when a psychologist takes a patient as his or her client. Moreover, any activity done with the client even if it is outside therapy boundaries is considered unethical. Many people deem that since these activities are not related to work they have no effect on the therapy itself. However, the associations classify any activity that may lead to exploitation as unethical and this includes activities and meetings outside therapy. However, there are situations where the meeting is unavoidable or by pure coincidence. In such a situation, the client cannot be charged with violation of boundaries.

The facts in this vignette are, the woman has an emotional problem and is seductive, we were involved in the same event, we have had a talk, and she is young and female while I am male. Moreover, I will be her psychology teacher, which means I am going to be in her presence for a greater amount of time. Hypothetically speaking, since the woman and I knew each other in the past, and she is covertly seductive, she may get me into a relationship without me realizing it. Her emotional fragility means that she is a hard person to deal with when it comes to relationships. This situation gives two points of view: ethical issues in class and in her therapy sessions since her psychologist is a colleague.

From the power dimension in a decision making model, the power I have over her in class is reduced. This is because the probability of the students applying my teachings is low compared to psychotherapy where the client is one on one with the therapist. However, the longer the time in contact with her means that despite the fact that I am not her therapist; the relationship may affect the performance of my colleague. The relationship will also affect my work in class since teaching a psychology class involves concentrating on the various personalities in the class. Instead of concentrating on all the personalities in the class, the personality of the young woman will cloud my judgment and my decision-making.

Since the meeting with her in EAP program as well as the local college was purely coincidental and unavoidable, there are no ethical issues concerning this case. Moreover, the code of conduct for any therapist requires confidentiality. Another thing is that I chose to direct her to a different therapist. Therefore, the activity of teaching is ethical since I am not her therapist. The fact that her therapist is my friend and I am her psychology tutor will not change anything. However, in another person’s view, this would look like a sexual dual relationship. The fact that the woman is emotionally unstable will provide the evidence that I took advantage of her situation. It would look like an unethical situation. The fact that there is no direct contact with the client in class gives me an easier time tutoring. Dealing with several people will mean that there is no contact with her and therefore my knowledge of her inadequacies will not affect my performance in class.

Since the job at the local college is pre planned and is a necessary undertaking, the best way to go about this is by avoiding the woman in situations outside the class. According to the power dimension, the less time I have with her, the less harm the relationship has on the sessions. I would also tell her that the fact that she is in my class would not affect her sessions with her therapists. There will be no need for a supervisor since she is not alone in class. Moreover, her therapist is a different entity from me. The other students in the class will act as a diversion and reduce the probability of any harm in this situation.

Since there is no prior knowledge of any relationship with the client, documentation and record keeping issues are not likely to occur. The fact that all the contact with the young woman are all coincidental does not put me in any collision with the ethics of my practice. Moreover, in a class situation, I am dealing with several clients. Therefore, there is no sharing of personal information like the casein psychotherapy.

Vignette Three:

Several if not all ethical codes from several associations such as ACA, USABP, et cetera discourage bartering associated with therapy. There are two kinds of bartering, that is goods and service bartering. Goods’ bartering is seen as a mild form of bartering and cannot bring any type of complication. This is because in the event the client and the therapist disagree on a particular matter concerning the good, it can be returned to the original owner. Moreover, there is little emotional attachment when it comes to exchanging a certain product with a service in this case therapy. Conversely, service bartering is highly discouraged by psychologists all over the world. It is classified under dual relationship and therefore the determination of boundary violation is done with consideration of the ethical codes that govern dual relationships. The discouragement comes in the wake of several possible cases of therapists taking advantage of their clients. The service is likely to be problematic in the case where either of the parties is not happy with the arrangement. Another factor that makes the action unethical is the fact that the fee charged by the client is lower than that charged by the therapist. The discrepancy in the fees means that the client has to put in more work hours, which puts him at a disadvantage. An agreement of service bartering can be done two ways. One, each hour a client puts in is equivalent to a session in therapy and two, the client can be paid in money terms for every hour he/she works.

The facts in vignette three are, first, the client has a mental condition that needs monitoring, secondly, he has just lost his job and may lose more in the future, thirdly, I have a job that suits what he requires, and fourth he is Hispanic. My decision will be based on the fact that the patient needs medical attention that is not allowed by his financial situation. The other thing is that his condition needs just two visits a month. The patient has lost a lot, which brings the notion that his mental condition might deteriorate. Therefore, he needs more attention than before. With regard to the code of ethics put out by the APA, CAMFT, ACA, AATA, and NASW, it is not recommended for me to accept the deal, but considering his dire situation and the necessity of medical assistance, I would allow him to work on the repairs sin my office. He does not have to put in a huge effort since he only requires a little work that would enable him have two sessions per month. Moreover, since he is Hispanic, his culture view bartering as part of life. It is not a big deal or them to be seen doing such work and therefore a complication is not likely to occur.

A complication may arise, but the satisfaction I will get in doing a favor for this man brings a good feeling. If the patient does not get medical assistance his condition may worsen, which means that I have broken a code of conduct of service to the patient. When the bartering agreement is done with integrity will not amount to a violation of the ethics of conduct. The process will be done such that the cost of his services will be determined. Its cost will then be equated to the cost of the therapy session. An arrangement that is acceptable to him will then be used in putting out the method of payment.

A supervisor will be available in the sessions as well as when the agreement is signed since complications may arise in the future. Moreover, since service bartering is considered unethical because of the notion that the psychologists take advantage of their clients, it would be useful to have a witness that will vouch for the good nature of the arrangement.

The plan for the sessions will be hard to document since the payment method will be inconsistent. Record keeping will also pose some problems since the method of payment is required to be noted in the records. A record of the client’s work as well as mine on the therapy sessions with the client is required. These records should be made in an impeccable manner, which means a professional should be hired to work on it. A third party should also draft an agreement of the arrangement. The involvement of a third party in this arrangement poses danger to the confidentiality aspect of this profession and its documentation and record keeping.

The ethical aspect of helping this man outweighs its unethical side simply because the process can be done in a thoughtful and sensitive manner. In addition, the patient needs as much help as he can get to avoid his condition deteriorating. Expectations of a problem occurring in the future should not be a deterrent in doing justice to a loyal client.

Vignette Four:

The cultural aspects and factors of the client influence boundary crossing. According to the codes of ethics, reception of gifts from clients should be scrutinized properly. These professional psychological associations are aware of the fact that gifts are influenced by culture. There are certain communities who consider gifts as a token of appreciation. In their ethics of conduct, these associations have left the determination of the reception of the gifts to the psychologists. However, they do advise the relationship to the client as well as the financial worth of the gift to be put into consideration when receiving the gift. It is very important to gauge the type of relationship that the therapist has with the client before accepting the gift. This is because the gift might not be meant to be just a gift but so that a favor may be afforded in the future. In a situation where the gifts worth is great, the situation may be taken as exploitation of the client.

In another aspect, activities undertaken with the client that are not related to the therapy are considered non-sexual dual relationships. These relationships are subject to scrutiny by laws that govern their occurrences. If the activity is known to undermine the psychological practice or exploit the client, then they are considered unethical.

In my situation, two factors are combined: the presence of a gift and an activity outside therapy sessions. The combination of these events provides a tricky situation because it is a clear indication of unethical practice when one looks at its literal side. The expensive gift and the invitation to the event may mean that I am taking advantage of the relationship that I have with this particular client.

The gift has a huge significance and value to the family and the deceased because it is an antique. The gift is a sign of good will from the family due to years of service to the family. There is a great friendship between the family and I because I offer my service to the whole family. Moreover, the relationship that has lasted for over a decade has strengthened and created ties with the family. The reception of the gift would be ethical since it is neither exploitative nor has a hidden agenda considering that the family is black-American and view gifts as a sign of gratitude.

On the other hand, speaking at the memorial may institute misconduct in the view of people who have no record of the relationship with the family. Considering the culture of the black American, boundaries in therapy is not condoned. They view anybody in their service as one of their own and like being in contact with them. The event would be welcomed since I would interact with them this interaction will improve the relationship and the working experience with the family hence improving the service. In this case, boundary crossing will be ethically agreed since it will bring more good in the end. My decision-making will also be influenced by the cultural practices of my client and our personal relationships that has grown in stature with service over the years.

The presence of a gift in the whole arrangement may appear as an exploitative attempt on my part. My relationship with the clients may be deemed as exploitative because on top of attending their memorial, I was given a valuable gift. Therefore, a supervisor should be present in the memorial. This supervisor should be made aware of the past and present relationship with this family to avoid any misinterpretation of the situation. The supervisor will note the words in my speech and present it to any interested party whenever it is deemed necessary.

The documentation of the healing plan for the family will not change because the relationship with the family has existed for over ten years. The invitation to the memorial shows trust and respect of the family for me as a person and for the service offered. This means that the treatment and counseling plan has been working well for the family. Therefore, no documentation issues will arise in this case. The fact that the family is black-American absolves me of any wrongdoing in the reception of the gift. It is a known fact that black-Americans are welcoming people. Thus, their event and gift were given in good faith. None of these activities put me bad light concerning my practice. Therefore, records will indicate the gift and the event. No recordkeeping issues will arise due to the gift and the event.

Issues may arise when boundaries are involved. Gifts and invitation to events present a tricky situation when classifying if a situation is rated as a boundary violation or just a boundary crossing. Factors such as culture that influence boundaries and how to relate to them should be put in practice in the determination of the nature of these events.

Conclusion

The determination of the nature of an event or a situation should not be taken on a face value. Several events, situations, and factors act as an influence of the intended actions. Boundaries are meant to affect the therapy sessions positively. However, blind application of these boundaries and the codes of conduct may derail the treatment of the clients. For instance, implementation of the codes may lead to the deterioration of a particular situation. A specific example is the case of the Hispanic man who had lost his job. Therefore, the codes and the boundaries should be thoroughly scrutinized before application.

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